• World Neurosurg · Dec 2024

    Prognostic model to predict outcome of adult tuberculous meningitis patients undergoing Ventriculoperitoneal (VP) shunt surgery: A prospective observational study.

    • Saddam Ahmad Hasib, Imran Rizvi, Ravindra Kumar Garg, Ankur Bajaj, Hardeep Singh Malhotra, Neeraj Kumar, Ravi Uniyal, Shweta Pandey, Rajesh Verma, and Praveen Kumar Sharma.
    • Senior resident, Department of neurology, King George's Medical University, Lucknow, India 2266003.
    • World Neurosurg. 2024 Dec 11.

    BackgroundPrognosis of adult tuberculous meningitis patients undergoing a ventriculoperitoneal (VP) surgery is not well known. Prognostic models developed to predict the prognosis might help the clinicians immensely.MethodsThis was a prospective study. Adult (≥18 years) patients of tuberculous meningitis undergoing VP shunt surgery were included in the study. Patients were followed for 6 months. Primary outcome was death, secondary outcome was composite outcome of death plus disability. Prognostic models were developed using the binary logistic regression. The model performance was assessed using discrimination and calibration. Internal validation of the model was done using boot strap. The models were plotted on nomogram and e-calculator for bedside use.ResultsOut of 92 patients, 28 (30.4%) died and 36 (39.1%) suffered a composite poor outcome. The final model showed MRC grade III, papilledema, seizures and size of temporal horn to be predictors of poor outcome. The models showed good discrimination; AUC of 83.7% (95% CI 75.1- 92.3%, P<0.001) for death; and AUC of 84.7% (95% CI 75.9- 93.5%, P<0.001) for composite poor outcome. Both the models showed good calibration; Hosmer and Lemeshow test P value 0.448 for death 0.093 for composite outcome. The model remained valid after performing bootstrap procedure, thus signifying internal validation.ConclusionAbout 39% adult tuberculous meningitis patients die or remain disabled after VP shunt surgery. MRC grade III illness, papilledema, seizures and size of hydrocephalus are the most important baseline predictors that can help in prognostication. The nomograms developed may help the treating physician in prognostication.Copyright © 2024. Published by Elsevier Inc.

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